A Temporal Trends Analysis Showing Improved Outcomes among Women with Acute Coronary Syndrome: The ACSIS Registry Data (2000-2016)

Background: Cardiovascular disease is the leading cause of death in elderly women. Despite improvements in the management and prognosis of patients with acute coronary syndrome (ACS), women with an ACS remain at higher prognostic risk.

Aim: To examine temporal trends in mortality and major adverse cardiac and cerebrovascular events (MACE) among women admitted with an ACS.

Methods: Time-dependent analysis of the management and clinical outcomes of women admitted with ACS who enrolled in the prospective biennial ACS Israeli Surveys (ACSIS) between 2000 and 2016. Surveys were divided into 3 time-periods (2000-2004, 2006-2010 and 2013-2016). Clinical outcomes included 30d MACE (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality. Results: During the study period, 3518 women were admitted with an ACS. Their mean age (70 +12 years) has not changed among the 3 time-periods. During the more recent time-periods, more women were admitted with non ST-elevation ACS (28.5%, 42.0% and 52.2%, respectively; p <0.001), use of statin was more common (66%, 91%, 93%, respectively; p<0.001), and PCI was increasingly utilized (42%, 60%, and 68%, respectively; p<0.001). Specifically, among women with ST-elevation ACS, more primary PCI were performed (48.5 %, 84.7%, and 95.3%, respectively; p<0.001). The rate of 30d MACE has significantly decreased over the years (25%, 19% and 13%, respectively; p<0.001). However, 1-year mortality rates declined only from 2000-2004 (17%), but remained stable (13%) over the past decade (p=0.007 for the overall difference)(Figure).

Conclusions: Over the past 16 years, both 30d MACE and 1-year mortality have significantly decreased among women admitted with an ACS. Advances in contemporary pharmacological treatments and an early invasive approach may have accounted for this improvement. However, the lack of further reduction in 1-year mortality rates among women over the past decade suggests that more measures should be provided in this high-risk population.